Perhaps they're still there, inside the shoes... or maybe he was just self-conscious, ok? Nothing wrong with a little extra work being done, after the nose job. He could have gotten a 2-for-1 special that day!
Looking at that side-angle though I feel like the back head-fin looks a bit too big seeing as the nose was made smaller. The hat in the front picture reminds me of those British police bobby hats. Still hate the look the helmet creates on the neck-area. I feel sorry for the guy's adam's apple.